COLORADO LIMITED WINERY ANNUAL PRODUCTION CERTIFICATION Pursuant to 12-47-403(1) C.R.S., _________________________________________________, (Licensee Name) d/b/a _____________________________________________ Colorado Limited Winery License Number_______________________, hereby certifies that not more than one hundred thousand gallons, or the metric equivalent thereof, of vinous liquor was produced within Colorado during the calendar year ending December 31, 20______. I declare under the penalty of perjury in the second degree that this certification is true, correct, and complete to the best of my knowledge. I further acknowledge that this license may be subject to revocation for submission of a false certification. Signature Title Date This certification must be returned, no later than February 28, to: Colorado Department of Revenue Liquor Enforcement Division 1881 Pierce Street, Room 108A Lakewood, CO 80214 American LegalNet, Inc. www.FormsWorkflow.com